Model for a healthy NHS

WHATEVER the outcome of the present furore about the NHS, there are some pretty clear trends as to what it will look like in the future.

When it began in 1948, the priorities were different from today. Hospitals had to be rebuilt and large-scale infectious diseases, such as diphtheria, measles, whooping cough and TB, were still a menace.

The NHS was initially a large-scale bureaucracy controlled from the centre. Aneurin Bevan famously boasted that “the sound of a dropped bedpan in Tredegar would reverberate around the Palace of Westminster”. The private sector could not cope. The Government wanted to organise things to get results, as had happened in the war.

Nowadays, the problems are different. There is still a need for acute hospitals, but the main problems the NHS faces are those of aging and unhealthy lifestyles.

The way big organisations work has also changed. As management theorist Peter Drucker pointed out more than 20 years ago, large corporations devolve as much as they can to the front line. Sociologist Richard Sennett has reminded us, though, that there is still strict financial control from the centre. Management is devolved, but it must deliver value for money.

The NHS can no longer work in isolation either.

It must co-operate with social services and other local government programmes, such as housing and leisure, if it is to deliver results.

This means local co-operative working, and sometimes operating, as Professor Bob Hudson, from Durham University, has described it, at “the edge of chaos” – but it is the only way to go.

There is one more feature that will become more and more important. If people are to manage their conditions when they get older, or aspire to healthier lifestyles, they must work with the health professionals. You cannot become healthy in the long term simply by a doctor giving you a pill.

Exercise, or a better diet, means you have got to work at it yourself, preferably with help and advice from a professional. Similarly, when we get older we may suffer from various conditions that require certain treatments and regimes. We will have to be involved in managing them, even if it is only taking the right medicine, but it could mean modifying our behaviour.

So the NHS is not going to be something organised for us, but something we will have to be involved in.

So what does this mean in practice? Whatever happens, clinicians will be more involved in managing healthcare, although I feel this is best done within the framework of a primary care trust to ensure public accountability and ensure there are no gaps.

So how do we make sure that things are not simply left to the “experts”, but the public are involved?

In Easington, we already have practice-based commissioning. There are 17 GP practices and we are working towards a situation where all will have active GP forums of patients and other interested parties.

TWO of the practices are independently managed, so we are at present unsure whether they will continue under the new arrangements, but I hope they do, to continue giving a whole-area focus.

We have also established a Monitoring and Advisory Board (MAB) consisting of representatives from the GP forums together with other stakeholders such as the East Durham Trust and the town and county councils.

This board advises the actual commissioning board of GPs which makes decisions about what services to purchase from the hospitals, at present in conjunction with the primary care trust. The GPs can also channel funds into community-based programmes that will hopefully prevent and treat disease in a community setting so as to remove the need for patients to have to travel to hospital.

A good example of this is the programme to diagnose and treat chronic obstructive pulmonary disease, which is prevalent in the Easington area, locally. This programme has been nationally recognised as good practice.

So, is the only job for the members of the MAB to advise? No, the board has also begun to monitor the effectiveness of health policies in the area – the “M” in the title. But members are all aware that we will not succeed in dealing with either long-term conditions or unhealthy lifestyles without much more effort to involve the public.

When asked what they thought their role was, board members saw it as much more “active”

involvement rather than simply the more “passive” activity of advising or listening to information.

What this means in practice is that they help establish support groups to help those with particular conditions manage them.

Diabetes is a good example.

They are also keen to develop new techniques to encourage the “hard to reach” to follow healthier lifestyles. Official propaganda about healthy lifestyles often influences the “worried well” who care about their health, and are careful about what they eat and drink, or how much exercise they take.

We are all aware, however, that it doesn’t seem to reach many sections of the population at all. The only way to influence such people is by personal contact. They will take more notice of their friends than they will official leaflets. This technique of “social marketing”

is something the MAB is keen to develop.

A good example of a successful scheme is the Blackhall Health Forum, where the parish council has worked with local volunteers to promote various healthy-living programmes, ranging from outdoor activities to gardening, aimed at young and old alike.

Whatever the result of the present Government’s problems with the NHS, the future will mean far more involvement by patients and the public. After all, it is our NHS. In Easington we think we are developing a model that works, and I hope it goes from strength to strength.

David Taylor-Gooby is vice-chairman of the Easington Monitoring and Advisory Board.